GN-4020, 05/18 Order and Notice for Hearing on Temporary Protective Placement 24755.135, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Order and Notice for Hearing on Temporary Protective Placement Case No. A Statement of Emergency Protective Placement has been filed by [Name] . A Petition has been filed by [Name] requesting protective placement of the individual. guardianship and protective placement of the individual. THE COURT ORDERS: A preliminary hearing shall be held before NOTICE OF HEARING Date Time Location (Include Room Number) Court Official If you require reasonable accommodations due to a disability to participate in the court process, please call prior to the scheduled court date. Please note that the court does not provide transportation. Notice of time and place of the preliminary hearing shall be given orally and in writing to the individual. DISTRIBUTION: 1. Court 2. Petitioner/Individual/Ward 3. 4. 5. Guardian ad litem 6. 7. Presumptive Adult Heirs 8. Facility in which the Individual/Ward resides/Physical Custodian 9. 10. 11. Other: American LegalNet, Inc. www.FormsWorkFlow.com